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Bladder endometriosis must be considered as bladder adenomyosis
J Donnez1, F Spada, J Squifflet
1Service de Gynécologie, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. donnez@gyne.ucl.ac.be
Fertility and Sterility
|December 20, 2000
Summary
Bladder endometriosis is actually an adenomyotic nodule of the bladder, histologically similar to rectovaginal adenomyotic nodules. Surgical excision is recommended for bladder adenomyosis due to recurrence with medical therapy.
Area of Science:
- Gynecologic pathology
- Urologic oncology
- Minimally invasive surgery
Background:
- Bladder endometriosis presents with menstrual urinary symptoms and pelvic pain.
- Diagnosis can be challenging, often requiring advanced imaging.
- Recurrence after medical therapy necessitates surgical intervention.
Purpose of the Study:
- To analyze 17 cases of suspected bladder endometriosis.
- To describe the clinical presentation, diagnosis, and management.
- To clarify the histopathological nature of bladder adenomyotic nodules.
Main Methods:
- Clinical case series.
- Diagnostic workup including cystoscopy, IVP, and MRI.
- Laparoscopic extramucosal excision of bladder nodules.
- Histopathological analysis of resected tissue.
Main Results:
- 76% experienced menstrual mictalgia/pollakiuria; 88% had dysmenorrhea/dyspareunia.
- Imaging revealed bladder nodules adjacent to the uterus, involving the muscularis and often mucosa.
- 35% of cases were associated with rectovaginal nodules.
- Laparoscopic excision was effective, with recurrence noted after medical therapy cessation.
Conclusions:
- So-called bladder endometriosis is histologically an adenomyotic nodule.
- These nodules are similar to rectovaginal adenomyotic nodules.
- Frequent association (35%) with rectovaginal adenomyosis is observed.